PROJECT SUMMARY The intersection of tuberculosis (TB) disease with non-communicable disease, including chronic pulmonary impairment, has emerged as a critical clinical and public health obstacle. Rapidly expanding non-communicable disease epidemics threaten TB control in low- and middle-income countries, including Georgia, where preventing and treating TB disease remains a great burden. However, to date, the notion that TB disease may increase the risk of chronic non-communicable disease has not been well explored. We will determine the extent to which multidrug-resistant (MDR) TB, smoking, and biomarkers of lung inflammation contribute to increased prevalence of pulmonary impairment post-TB in the country of Georgia. This research will advance understanding of dual burdens of communicable and non-communicable diseases and build individual and institutional research capacity in Georgia. The long-term objective of this research is to elucidate the relationship between TB patient and TB pathogen factors with post-TB chronic pulmonary impairment, and strengthen research capacity for future work to identify treatment and prevention strategies that reduce the risk of chronic non-communicable diseases after TB treatment completion. The specific aims of this proposal are to: (1) determine the burden, predictors, and trajectory of pulmonary impairment post-TB treatment; (2) explore the relationship between biomarkers of lung inflammation and lung destruction at time of TB treatment completion with severity of pulmonary impairment; and (3) build increased research infrastructure and capacity for Georgia that is focused on the intersection of TB and chronic pulmonary impairment. The aims of this project will be achieved by enrolling a cohort of patients (n=130) at the time of TB treatment completion and following them prospectively for one year. At both time points this study will measure spirometry, pulse oximetry, and quality of life among patients who were treated for drug susceptible TB (n=65) and among patients treated for MDR TB (n=65). The analysis will include multiple modeling strategies to assess the relationship between patient and host factors and the risk of chronic pulmonary impairment. The proposed study will help to characterize the extent to which TB contributes to chronic pulmonary impairment and will identify which existing clinical respiratory rehabilitation interventions may be used to improve quality of life throughout the lifespan among patients with TB. In addition, this R21 will leverage a cadre of current and former Fogarty-supported trainees and provide invaluable mentored training experiences in the areas of TB and chronic pulmonary diseases. A long term goal of the proposed work is to prepare for prospective studies that follow patient cohorts beginning at the time of TB diagnosis, during TB treatment, and several years after TB treatment.